| NPI | 1750374104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53189) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 35071066) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2023-11-03 |